Link Roundup, 1/30/2018

From The Atlantic: A possible link between sugar and Alzheimers.

From Vox: What happens when you go to the ER without insurance.

From Politico: Amazon is planning to enter the health care business.

From The New Yorker: The elusive definition of death.

From NPR: Idaho wants to flout ACA coverage rules.

21 Comments

  1. I’m assuming this new non-profit organization will be available to those NOT employed by the three profit making organizations. As Mary points out self insurance by large corporations is common. So this would have to be different. This seems to be something that will be offered to others.

    I am not sure that this is evil. It may even be virtuous. I’m not sure what they have in mind, in detail, but it may be something that reduces the cost of healthcare and/or health Insurance. Keeping in mind that healthcare cost and insurance cost is not the same thing.

    I would point out the recent purchase of Aetna by CVS. Again, I’m not sure what they have in mind for a resulting product, but imagine a medical center in every CVS store where minor ailment can be treated, and more serious cases diagnosed and referred to hospitals. This would create low cost primary care and if installed in every CVS would place one in almost every neighborhood. In my city, it seems on every block. This would be much like Spain’s community health centers.

    Though all this debate, it seems that we conflate healthcare insurance with the actual costs of healthcare. Covering costs for every one would be much easier if those costs were lower.

    I’m eager to see what they have in mind and will stay open to their ideas.

  2. For once, I had already read all of the articles listed on your round up…because of my interest and experience in and around health care. The ER travesty is one that has become a major problem across our nation. State legislatures are only now starting to address the rampant costs associated with out of network medical services. There are laws and regulations that can impact this problem but the root cause is greed. Let me remind everyone that our MoC enjoy taxpayer subsidized Gold Plan health care (71% subsidy) while they pillage health care for the people of America. It’s unconscionable. Yet, the very people who are most at risk, reward those who are stealing parts of their life’s sustenance from them….with re-election. The Houston Chronicle (Jenny Deam) did a wonderful, very lengthy, detailed series on the ER issue, and VOX has been collecting personal stories and researching this issue for quite some time. Congress? Not so much. We are living in a very mean-spirited, self-serving time and people are being hurt.
    When will they start to vote out the people who are cutting programs that help them? When? (http://connect.tahp.org/news/376921/)

    I’ll tell you who understands what’s happening in health care: women. They “get” it. At every event I attend, health care is a major focus. Social capitalism is a neat, real term that is going to hit MoC and state legislators over the head sooner or later. My hope is it will begin with mid-terms.

    I am, however, suspicious of Jamie Dimond’s involvement. He has been too coy politically for me to see his involvement in this for anything other than profiteering. If all we are going to achieve with his presence is moving the deck chairs around from the United Health Cares and Anthems to the banks, I’m not interested. Until we take a hard, serious look at the experience of other industrialized nations in the world (T.R. Reid, “The Healing of America” and other works that study health care delivery on a global basis), we will be stuck with a hodge-podge of concepts. Can Bezos and Buffet deliver? Where is Google on this? Zuckerman? All of these billionaires who are social capitalists need to focus their energies and money towards an endeavor like this that really matters to individual people. Imagine how much better life would be for people if they didn’t have to worry about health care cost, access, quality? That they could get the care they need so that they could work, care for their families, save for retirement and educations for their children….Quality of life – without worry, fear. It matters so much and like so many others, I watch in dismay and frustration the games that are being played literally with people’s lives. It’s wrong.

    Thank you for a fine collection of posts on health care. I would like to add one thoughtful piece on death to this list.

    https://www.vox.com/science-and-health/2017/12/7/16690024/buddhism-health-care-death-mindfulness-spirituality

    And this article from Kaiser which illustrates the impact of health care costs for Medicare recipients….many of whom cannot afford a supplemental policy to Medicare and have to absorb the uncovered 20% expense. Families are being hurt at all income levels, and all coverage situations. It’s wrong.

    https://www.kff.org/medicare/report/medicare-beneficiaries-out-of-pocket-health-care-spending-as-a-share-of-income-now-and-projections-for-the-future/

    1. Dimon is as avaricious as they come. Bezos has created Darwinian conditions at Amazon. Buffet, he seems to be of the temperament and age to create a legacy of some kind. But the other two, I don’t understand their motivation to create such infrastructure. And at the very least, Dimon had to get buy-in from a board of directors.

      The only way I envision this working is if the people running these giga-corps expect to use this as a weapon against their employees. Imagine 15 or 20 years from now (Bezos will most certainly still be at the head of a trillion dollar company by then, Dimon retired, Buffet dead). Given that the current regime is entrenched now, and will most certainly control SCOTUS, the damage they will do to Medicaid, Medicare, and who knows what other safety nets is going to be massive.

      So 15 or 20 years from now, someone does not work for a company that has a great medical plan will be facing either private insurance that is devastatingly costly or playing russian roulette of no medical insurance. These conditions exist today to large extent, but will be far far worse soon enough. That scenario certainly is a motivator to be a very very good employee (read as indentured servant), one that works 80 hours a week, and says, “please sir, can I have some more work”, particularly if you have young children.

      All hail our new (or not so new) corporate overlords.

      1. Dins: “15 or 20 years from now, someone does not work for a company that has a great medical plan will be facing either private insurance that is devastatingly costly or playing russian roulette of no medical insurance. ”

        We are already there.

  3. The ballooning costs of (health care) act as a hungry tapeworm on the American economy,” Buffett said in a prepared statement.

    Funny, I’d say the same thing about buffett’s financial industry: https://tcf.org/content/commentary/graph-how-the-financial-sector-consumed-americas-economic-growth/

    Also, last I checked the Healthcare industry never required a multi trillion dollar bailout for fraud.

    Maybe we should have a low cost non profit banking system too?

    1. The finance industry’s public purpose to channel credit into productive uses. I don’t have a problem with profits, but finance is an overhead cost on those productive economic activities, and as any manager knows overhead must be minimized if the productive activity is to be optimized.

      The biggest scam that Wall Street has pulled is convincing people (mostly Congress, and mostly with bribes) that it is part of the real economy, whereas it actually is an overhead cost on the real economy. We need regulations that ensure that public purposes are the only purposes pursued by the financial industry. The fact that an activity makes a profit for Wall Street is not sufficient reason to allow Wall Street to engage in that activity.

  4. Looks like Chris may have been prophetic.

    From the Politico article, three giga-corps plan on providing not-for-profit medical care for their employees. Is this the first step where the oligarchy starts filling the void left by devastated government infrastructure? If I see Apple, Google, Facebook, or any of the traditional giga-corps join in, then I would say yeah, the first plug in the dyke by the oligarchs has begun.

    The irony of course is that these three for-profit corps have decided that not-for-profit medicine, the model adopted by most of the civilized world, is the best model. The idea of making a profit off of the medical misfortune of others is revolting.

    I can’t even imagine what the various political philosophers, across the entire spectrum, think of this.

      1. Republicans appear to be focused on a track of using power to make the key players in government who disagree with their agenda “disappear”. Those who thwart their goals in any way (by telling the truth), or daring to stand on principle – will now simply be “removed”….by the “democratic process”. How exquisitely ironic.

        Dins is correct that this is what happens in dictatorships and authoritarian regimes. In a book I am reading, “How Democracies Die”, by Harvard professors, Ziblatt and Levitsky, they have a whole chapter on the changes to society that precede destruction of democracies. They note that it is not always overt, rather, it is subtle and steady. See if you can connect this article to their research.

        https://www.washingtonpost.com/news/powerpost/paloma/the-health-202/2018/01/30/the-health-202-hill-republicans-and-cbo-go-another-round-after-obamacare-fight/5a6f743d30fb041c3c7d74a9/?

      2. Mary, when I said the de-evolution into whatever form of “official” non-democratic form of government is coming, I do indeed estimate it is in a matter of months, by that I mean no less than 12, more likely 18-24.

        When Mueller is fired, and Congress cheers, that, for me, is when the dominoes that have been falling get really obvious for everyone. I would love to see 1 million people march on Washington when the investigation is shut down, but that won’t happen. I also expect to see a bill in the House that will start throttling news organizations by loosening restrictions on suing them.

    1. EJ

      A) The high cost of medical care in Western countries is, as I understand it, driven primarily by the costs of looking after elderly people and people with severe ongoing issues.

      B) This company that JP Morgan, Berkshire Hathaway and Amazon have announced, will offer medical care to their employees (and presumably their spouses and children.)

      C) As such, this company will neatly sidestep the most expensive forms of medical expenditure.

      D) The people whom it does not cover, who are the most expensive, will have to either be covered by the taxpayer or by the medical insurance market. If the former, then the taxpayer is implicitly subsidising JP Morgan, Berkshire Hathaway and Amazon. If the latter, then by driving healthy people out of the insurance pool, this is going to push premiums up for everyone else.

      E) If D, then this is not good corporate citizenship.

      1. It’s called “self-insurance” and state and local government have utilized this approach. It’s risky with today’s high cost drugs and life-saving procedures for self-insured entities to assume the risks.

        The bottom line is America needs universal health care. Anything else is going to always be limited. America and Americans have to decide if health care is more important than other budget priorities. Like, walls, and cotton subsidies. It should not be an elitist service. Period.

      2. Actually, EJ, it’s more complicated than health costs for the elderly and those with severe health issues. It’s cost for care. Reputable studies have affirmed that Americans are actually going to the doctor less but paying more. I’m not blaming physicians here, (well, some of them are guilty of price gouging), but the entire process is broken. I take a very old, generic medication that should have a zero co-pay due to its age, cost, etc. Yet, when I price RX supplements each year, the co-pay for this drug is all over the map. Why? Why are standard procedures (MRI, Xrays, lab tests) priced in such a varying range? What is a reasonable payment for physician services? Why doesn’t America support more community health clinics. (They were expanded under ACA then quietly reduced and at present, Congress has not funded them in their budget…it was only through the political process that CHIP was funded and this program is a proven cost-saver, if you are only looking at cost-effectiveness and not quality of life benefits.)

        My point earlier is that there are economies of scale and process. During Hurricane Harvey, with so many people who are diabetics and on high blood pressure meds, these people were able to be monitored remotely through technology. Even as technologically deficient as I am, I recognize that tele-medicine can have huge benefits. Every trip to the doctor that I made with my husband was expensive. He required private transport due to his health condition. Medicare didn’t pay for this but Medicaid does. Or, used to. That’s another one of the changes that is being factored into Medicaid benefits. America can learn from other countries. The problem is that our health care system has become a huge for profit center – from the stocks (which are diving today on the Amazon/Buffet/JP Morgan news) and so on….with each lower level being squeezed more and more until you get to the final payee….the individual. Health care is America is great IF you are employed by a company that offers a quality plan, or are a MoC, or government employee. The rest of us are in this big soup bowl of chance.

      3. Curiously, is there any enforcement mechanism within current law to manage something as unprecedented as all this? As long as ABJP keep their healthcare scheme within the confines of their own companies, it seems fair to classify this as just an extension of employee-sponsored healthcare, though I’m honestly at a loss as to what to call them if they move beyond that. If they don’t offer insurance plans in the traditional sense, you can’t call them a part of the insurance market, and so how do you regulate something like that, if at all?

        Furthermore, how do you think insurance companies would react if this venture goes along more or less unimpeded? They’re powerful, but if I had to bet my chips between them and the three-way all-powerful behemoth of Amazon, Berkshire, and JPMorgan, I know where I’m hedging my bets.

      4. Until they move beyond their own employees, they have a great deal of flexibility. However, my understanding is that the ACA still comes into affect due to the number of employees each has. Essential basic coverage elements apply.

        I see this as a controlled experiment that demonstrates what health care without profit requirements can accomplish….in premium rates, efficiency, breadth, participation, health outcomes due to affordable, accessible health care as well as quality of life measures at home and in the workplace. It could also offer a test of sorts to what universal health care might be like when people can work without the stress of worry about health costs and coverage.

        The stock market tumble today clearly demonstrated that this type of independent action is threatening to the big boys in the health care field. It’s about damn time someone jerked their chains!

      5. “America and Americans have to decide if health care is more important than other budget priorities. Like, walls, and cotton subsidies.”

        Mary, that’s a false choice. Health care doesn’t compete for resources with walls and cotton subsidies. We have most of the resources (doctors, nurses, hospital beds, pharmaceuticals) we need to provide universal health care. There’s no need to decide between that and anything else.

      6. My comment was pure snark. Of course healthcare should be a priority and should be affordable and universal. Unfortunately, those in political power do not agree – even as they suck at the teat of the taxpayer with their own subsidized health coverage plan.

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